lines and tubes
TRANSCRIPT
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LINESANDTUBES
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LINES AND TUBES
ETT Tip 5cm from carina
Tracheostomy tube tip way between stoma and carina
Central venous catheter Tip in SVC
Swann-Ganz Catheter Tip in proximal R or L Pulmonary Artery
Umbilical Catheter T 12, proximal to the right atrium in the IVC(just above the diaphragm on X ray
Pleural Drainage TubeAnterosuperior for PTX;
posteroinferior for effusion
Pacemaker Tip at apex of R ventricle; other(s) in RA
Intraaortic Ballon Pump Aorta descendens
NG tube Tip in stomach
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AIRWAYS
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ETT
Tip of endotrachealtube (yellow arrow)lies well above the
carina (green arrow)
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TRACHEOSTOMY
Tip of tracheostomytube (yellow arrow)lies about midwaybetween the stoma
(blue arrow) andcarina (green arrow)
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INTRAVASCULAR LINES
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CVP
Tip of central venouscatheter (yellowarrow) curves gentlydownward into
superior vena cavaUsed in critically ill
patients
For venous
access
Measurement
of central
venous pressure
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CVP
Placement beyondthe superior venacava may also bedetrimental.Arrhythmias orcardiac perforationsmay result fromplacement of lineswithin the heartIntracardiac
placement of acentral venouscatheter (arrow). Thetip (small arrow) iswithin the rightventricle
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CVP
Close up view of
chest x-ray showing
catheter tip in the
external jugular
vein. Each cathetershould be followed
to its tip so that an
abnormality like this
one on the edge of
the film is notmissed R3
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Swann-Ganz
Catheters
Swan-Ganz catheters (pulmonarycapillary wedge pressure
monitors) are used to measure
pulmonary wedge pressures.
Pulmonary capillary wedge
pressure catheters (PCWP) are
introduced percutaneously into
the venous system. They areadvanced through the right heart
and into the pulmonary artery.
The catheter tip should ideally be
positioned no more distally than
the proximal interlobar
pulmonary arteries. A good ruleof thumb is that the catheter tip
should be within the mediastinal
shadow. Placement more distally
increases the chance of
pulmonary infarction or vessel
rupture.
Monitors
Chest x-ray showing location of Swan-
Ganz catheter tip (arrow) in the rightpulmonary artery
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Swann-Ganz
Catheters
Malpositioning of PCWPcatheters is exceedinglycommon, found inapproximately 25% ofcatheters placed. This maylead to false readings and anincreased risk for
complications.Complications of PCWPcatheter placement includepneumothorax, pulmonaryinfarction, cardiacarrhythmias, pulmonaryartery perforation,
endocarditis, and sepsis.
Improper positioning of aPCWP catheter in the distalbranches of the pulmonaryartery.
Catheters
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Catheter position The umbilical artery catheter should be
positioned at a high position above T 12. The umbilical venous catheter should ideally
be placed just proximal to the right atrium inthe IVC (just above the diaphragm on X ray
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Frontal radiograph of abdomen
shows that umbilical venous
catheter enters abdomen at
umbilicus (small arrowhead),travels in cephalad direction in
umbilical vein (double black
arrows) (note that catheters
cross just above umbilicus),
courses through left portal vein
and ductus venosus, entersinferior vena cava, and
terminates in right atrium.
Umbilical artery catheter also
enters abdomen at umbilicus
(single black arrow) but extends
inferiorly (white arrow) andposteriorly into iliac artery
before coursing superiorly in
aorta (large arrowheads).
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Used to remove eitherair in or fluid in thepleural space
Ideal position is
anterosuperior for PTX
and posteroinferior foreffusion
Pleural Drainage Tube
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Tip of thoracostomy
(pleural) drainagetube (yellow arrow)
lies in the apex of
the right
hemithorax. The
side hole (blue
arrow) is well withinthe chest.
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This chest tube
failed to remove the
pleural effusion due
to anterior
placement
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CARDIAC DEVICE
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Two-lead pacemaker(red circle)
shows one lead in right atrium
(greenarrow)and the second in
the right ventricle(red arrow).
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Tip of intra-aortic balloon
pump (red arrow) lies just
below top of the aortic arch
(green arrow) and heads
slightly to the right.
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Tip of intra-aortic balloon pump (yellow
arrow) lies about 2 cm from top of aortic
arch (blue arrow)
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TERIMA KASIH